Applying an equity lens to assess context and implementation in public health and health services research and practice using the PRISM framework

Frontiers in Health Services

Health Services

Russell E. Glasgow¹  Spero M. Manson²  Meredith P. Fort³ 

[1] Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, and Eastern Colorado Veterans Administration, Aurora, CO, United States;Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States;Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States;Aurora, CO, United States;

关键词: re-aim;    implementation;    context;    practice;    PRISM;    representation;    reach;    health equity;   

DOI  :  10.3389/frhs.2023.1139788

 received in 2023-01-07, accepted in 2023-03-13,  发布年份 2023

来源: Frontiers

【 摘 要 】

Dissemination and implementation science seeks to enhance the uptake, successful implementation, and sustainment of evidence-based programs and policies. While a focus on health equity is implicit in many efforts to increase access to and coverage of evidence-based programs and policies, most implementation frameworks and models do not explicitly address it. Disparities may in fact be increased by emphasizing high intensity interventions or ease of delivery over meeting need within the population, addressing deep-rooted structural inequities, and adapting to local context and priorities. PRISM (Practical, Robust Implementation and Sustainability Model), the contextual expansion of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework has several elements that address health equity, but these have not been explicated, integrated, or illustrated in one place. We present guidance for applying PRISM with an equity lens across its four context domains (external environment; multi-level perspectives on the intervention; characteristics of implementers and intended audience; and the implementation and sustainability infrastructure—as well as the five RE-AIM outcome dimensions. We then present an example with health equity considerations and discuss issues of representation and participation, representativeness and the importance of ongoing, iterative assessment of dynamic context and structural drivers of inequity. We also elaborate on the importance of a continuous process that requires addressing community priorities and responding to capacity and infrastructure needs and changes. We conclude with research and practice recommendations for applying PRISM with an increased emphasis on equity.

【 授权许可】

Unknown   
© 2023 Fort, Manson and Glasgow.